Geographic disparity in access to deceased-donor liver transplantation (DDLT) is largely uncharacterized for pediatric candidates. We investigated geographic disparity in DDLT rates across Donation Service Areas (DSAs) for pediatric liver candidates using a robust metric of disparity before and after Share35.

METHODS: Using SRTR data 6/2010-6/2016, we identified 4,690 pediatric (<18yrs) liver transplant candidates and estimated PELD/MELD-adjusted DDLT rates using multilevel Poisson regression. PELD/MELD was categorized empirically. From the regression model, we derived the incidence rate ratio (IRR) of DDLT rates between each pair of DSAs and the median of the IRRs (MIRR). MIRR is derived from the variation in DDLT rates across DSAs and represents an overall measure of geographic disparity. Larger MIRR indicates greater disparity.

RESULTS: In the three years pre- and post-Share35, MIRR was 1.98 and 1.89, respectively. In other words, two pediatric candidates with the same PELD/MELD in different DSAs were expected to have a 1.98-fold difference in DDLT rate pre-Share35 (MIRR = 1.98), and two candidates with the same PELD/MELD in different DSAs were expected to have a 1.89-fold difference in DDLT rate post-Share35 (MIRR =1.89). Comparing MIRR to the impact of PELD/MELD on DDLT rates, after Share35 an increase in PELD/MELD from 29-34 to 35-40 was associated with 1.90-fold higher rate of DDLT (Table 1B, Col. 2) and an increase from 35-40 to Status 1 was associated with a 3.7-fold higher rate, while relisting in a different DSA could increase a pediatric candidates' rate of DDLT by 1.89-fold.

CONCLUSION: Geographic location is a major determinant of access to DDLT for pediatric candidates, and there was minimal change in this disparity following Share35.

CITATION INFORMATION: Bowring M., Mogul D., Segev D., Gentry S. Geographic Disparity in Access to Deceased-Donor Liver Transplantation for Pediatric Candidates Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress